The Complete Guide To Gum Grafting
What Is A Gum Graft And Who Should Get One?
Gum Graft Procedure
A gum graft is a surgical procedure performed by a periodontist to correct gum recession or an uneven gum line. Typically, the procedure involves removing tissue from the roof of the mouth and stitching it to the gum tissue around the affected tooth or teeth, restoring the gum that was lost due to gum recession or evening the gumline for cosmetic purposes.
If you are suffering from a receding gum line, your dentist will probably refer you to a periodontist for a gum graft. When left untreated, receding gums can cause a lot of damage to your teeth, jaw and mouth. A receding gum line exposes the root of the tooth, where the nerve endings are, making your teeth sensitive to cold or hot foods. The roots of the tooth aren’t protected with enamel like the rest of the tooth, so if they are exposed, they are prone to decay and eventually you could lose the tooth, or teeth. Treating gum recession as early as possible is extremely important.
Some people choose to get a gum graft for cosmetic reasons. If you have an uneven gumline or some teeth appear larger than others, a gum graft can be performed to correct asymmetry. (Though, if some teeth appear larger than others, this could ultimately be because of receding gums.)
Once the tissue is removed from the palette, or roof of the mouth, a periodontist will secure it to the exposed root of the tooth, or teeth, and then pull the existing gum over the borrowed tissue, securing the tissue and gum with stitches. The goal is for the palette tissue and gum to reattach itself to the root surface of the tooth, giving the tooth structure and support. The procedure is permanent and should not have to be performed more than once, though a patient may need another gum graft if gum recession appears in a different area of the mouth.
Gum grafting using connective tissue can be traced back to 1985 when the procedure was first described. Today, it is a common surgical procedure, minimally invasive, with a relatively short recovery time.
If you’ve noticed your gum line changing, if any of your teeth are appearing larger than the others, or if you are experiencing sensitivity when you eat cold or hot foods, alert your dentist as soon as possible. A gum graft could be your saving grace.
More Reasons You Might Need A Gum Graft
The most common reasons to get a gum graft are, as we mentioned above, gum recession and cosmetic purposes. But here are a few other reasons you may need a gum graft—all related to gum recession but in different, and perhaps surprising, ways:
If you are genetically predisposed to having thin gums, you may need a gum graft to help enforce your gums. Thin gums are especially prone to recession, so getting a gum graft will help prevent future recession and strengthen your existing gums.
Lack of keratinized tissue
Keratinized tissue is the gum tissue that surrounds the tooth. If you don’t have enough keratinized tissue, you lose the gums that’s supports the teeth and allows you to chew, brush, etc. Once keratinized tissue is lost, it cannot be regained, no matter how often you floss. So a gum graft is needed to replace that important gum tissue.
If you had braces at any point in your life, you could be more susceptible to receding gums. Each year, about 400,000 Americans develop gum disease or gum recession caused by orthodontics. This is for a couple of reasons. First, having braces makes maintaining oral hygiene difficult, and poor oral hygiene can lead to gum disease which leads to receding gums. Second, the pressure that braces put on teeth to move them can cause the gums to be inflamed and can cause bone loss—both of which can lead to gum recession.
If you haven’t had orthodontics but you’re planning to, your dentist may recommend getting a gum graft surgery in preparation for braces or other orthodontia.
Other causes of gum recession that might lead to needing a gum graft include toothbrushing technique—brushing your teeth too vigorously for example—periodontal disease, a tooth in an abnormal position, or lip and tongue piercings.
What Is A Gum Graft Procedure Like?
A gum graft procedure is relatively short and simple, lasting between 45 minutes and an hour and a half. The most common type of gum graft is a connective tissue gum graft, but there are a few different types depending on your teeth and gums. The main difference between the procedures is where the graft is taken from.
Connective Tissue Graft
For a connective tissue graft, your periodontist will numb the tooth area as well as the skin that will be grafted. After applying the local anesthetic, your periodontist will clean the exposed root surface of your tooth, or teeth. In some cases, a periodontist may apply a regenerative protein at this point in the procedure to help the gum tissue connect to the grafted tissue.
After anesthesia, your periodontist will prepare the existing gum line for the grafted tissue by making a pocket. Then, he or she will make an incision on the roof of your mouth and remove a piece of connective tissue beneath the top layer of tissue. The connective tissue will then be transferred to the exposed root where the pocket was made in the gumline. Then everything will be secured with stitches, and voila! You’re done. Sort of. There is still recovery time and follow-up visits to make sure the graft is adhering to the tooth correctly and for stitches removal.
Free Gingival Graft
This type of graft is typically used on someone who has naturally thin gums that are in danger of recession. The procedure is similar to the connective tissue graft but instead of using connective tissue from the roof of the mouth, a periodontist will use surface-level tissue and attach it to the existing gum to fortify it.
This procedure uses local gum tissue, instead of tissue from the roof of the mouth, to cover the receding gum area. Your periodontist will cut a flap of tissue from the existing gum right next to receding gums. They will use this flap to cover the receding area. You must have enough excess gum tissue for this procedure to work.
Your periodontist will know which procedure is best for you. All three procedures are outpatient surgeries and use a local anesthetic, meaning minimum time spent in the chair and recovery.
What You Should Know About A Gum Graft Procedure
Aside from knowing how the actual procedure works, it’s helpful to be as prepared as possible for your gum graft surgery by knowing exactly what to expect. Even though it’s minor out-patient surgery, there are always at least a few nerves when anticipating an operation. We hope some of the facts below will help put your mind at ease.
Don't go to surgery alone.
Have someone drive you to the surgery and back home. They should also stick around to hear about post-surgery instructions. Even if you only use the local anesthesia during your surgery, you will likely be on pain medication directly after it, meaning you may not be cognizant enough to remember your periodontist’s instructions.
Ask about your anesthesia options.
As we mentioned above, most gum graft surgeries only require local anesthesia, but you can opt for a more intense anesthesia if you prefer. Talk to your periodontist about this beforehand. If you have severe anxiety over dental procedures, you can get an IV drip anesthesia that will put you completely under for the procedure, or you can get a drug called Halcion that will make you consciously sedated. This may depend on what your insurance will cover, but make sure you ask your periodontist about your options so you can be as comfortable as possible.
The pain isn't too bad.
Most people compare the pain to a pizza burn on the roof of your mouth. The area where the graft comes from may feel like this for a while. You could also have some bleeding in the affected areas. For this, you can use a stent that covers the roof of your mouth. This will help stop the bleeding and will keep you from touching your stitches with your tongue. Ask your periodontist about this before surgery.
Prepare for recovery.
We talk more about recovery from a gum graft below, but be sure to stock up on soft foods such as soups, smoothie ingredients, and ice cream before your surgery. This will be all you will be able to eat for a few days.
Complications are rare.
It’s rare to have serious complications from a gum graft but the following can occur:
Graft tissue fails to graft to the new site
Swollen or bleeding gums
Loose or sensitive teeth
Space appearing between the teeth
Talk to your dentist or periodontist if you are experiencing any of these complications.
Benefits of a Gum Graft
Although the gum graft procedure takes time, can be a bit painful and requires a few days of recovery, it is worth it. There are many benefits to a gum graft, both health and appearance-related.
It will give you a younger looking smile.
Receding gums can make you look older than you are. Some patients choose to get a gum graft simply to restore their youthful smile. When you no longer have the look of receding gums, your smile will appear years younger.
It will give you a more even smile.
Other patients opt to get a gum graft due to an uneven gum line. This could be because of receding gums or simply genetics. Either way, a gum graft can even out your gum line and, therefore, your smile, giving it a more engaging, symmetrical look.
It will protect your teeth.
When the roots of your teeth are exposed due to receding gums, you are at risk for bacteria buildup on the teeth that could lead to disease as well as tooth loss. Because the gums are connective tissue that help attach your teeth to the bone, you could lose your teeth if that structure is lost. With a gum graft, that connective tissue and support are restored, and you don’t have to worry about seeing your periodontist for dentures or implants in the future.
It will strengthen your gums.
If you have thin gums, as mentioned in Chapter 2, a gum graft will restore your thin and weak gums to a healthy thickness that is able to support and hold your teeth in place. A gum graft will also prevent future gum recession that thin gums are prone to.
It will reduce or help eliminate tooth sensitivity.
If you have receding gums, you may have experienced an increased sensitivity to food and beverages. This is because the gums are designed to cover the nerve endings on the tooth. When the nerves are exposed because the gum has receded, your teeth will be much more sensitive. A gum graft will take care of this by covering the exposed root, allowing you to take a sip of that cold beverage without thinking twice.
It will save you money in the long run.
While a gum graft can be expensive (we talk about cost in more detail in Chapter 7), it could save you a lot of money in the long run. If you don’t get a gum graft when you need one and your gums continue to recede, you could face major health complications such as losing your teeth, which you would then have to correct with more expensive implants or dentures. If you have periodontal disease, your condition could worsen, meaning you’ll have to spend money on additional treatments and appointments that could have been corrected with one procedure.
How Long Does It Take To Recover from A Gum Graft?
Like the gum graft procedure itself, recovery time for a gum graft is relatively short and sweet. It typically takes one to two weeks to fully recover. For the first few days, you’ll want to have a clear calendar. You might not want to go to work or attend social events. Your gums might be bleeding occasionally, and your mouth might feel and look a little…funky. You probably won’t want to be around too many people and you certainly shouldn’t be doing any strenuous activity, so it’s best to lay low.
While you’re recovering, you may experience some pain on the roof of your mouth where the graft was taken. Many people compare this to the type of pain you experience when you bite into a piece of too-hot pizza and get a pizza burn. Your periodontist will prescribe pain medication. Take it as instructed and you will be able to manage your pain easily.
For your graft to correctly attach to the gums, it’s crucial that you follow all post-operative care instructions from your periodontist. As we mentioned in Chapter 4, make sure you have someone there with you at the surgery. You might be on anesthesia or pain medication and unable to recollect what your periodontist told you.
Your periodontist will probably suggest avoiding foods that are hard to eat and only eating soft foods for a few days. Smoothies, eggs, yogurt, ice cream—anything that’s easy on your teeth and gums.
After surgery, you shouldn’t brush or floss the affected area. Your periodontist will probably give you a mouthwash to use in the meantime and you might need to take antibiotics to help fend off infection.
Ask for a stent for the roof of your mouth from your periodontist. This will help with bleeding and will keep you from playing with your stitches with your tongue. It will also keep food from getting into the affected area.
After a week or two, you will have a follow-up appointment with your periodontist to have your stitches removed. At this point, your mouth will be back to normal and you can resume your regular life. Your periodontist will probably provide brushing and flossing instructions, and she may not want you to get a cleaning at your dentist until she can ensure the graft has been successful.
Although it’s rare, some people do experience complications after their gum grafts. Worst case scenario? The graft fails to adhere to the gums, but this is extremely rare. Infection is the complication you want to be on the lookout for. Signs of infection include fever, extensive bleeding that lasts for more than 20 minutes, swelling in the gums or pus, bruising, and abnormal pain (worse than what we described above). Call your periodontist or dentist if you experience any of these symptoms.
Most people have no problems recovering after a gum graft. Go grocery shopping before surgery and load up on soft foods, clear your calendar for a few days, get your Netflix queue ready, and you’ll be fully prepared for your recovery.
How Much Will a Gum Graft Cost?
Gum Graft Cost
The cost of a gum graft depends on several factors, such as:
Type of gum graft
How many teeth need a graft
Whether or not you have insurance and what kind
What type of anesthesia is used
Where the grafted tissue is obtained
Gum Graft Cost Examples
You should anticipate other costs such as X-rays taken before surgery and follow-up appointments in addition to the cost of the procedure.
For this reason, it’s difficult to estimate exactly how much your gum graft will cost without talking to a periodontist and insurance provider first, but we can give you an idea of the range of expenses you may acquire.
According to Cost Helper Health, the base cost for a gum graft performed on one tooth or in one small area is $600 to $1,200 per tooth. The cost of X-rays is $150 to $600. If you have dental insurance, your provider might cover all or part of the surgery and X-rays. But be sure to check your dental plan. Not all of them cover major surgeries.
For example, United Health Care’s Dental Primary and Primary Plus plans do not cover “major services,” which include oral surgery. But their Primary Preferred and Primary Preferred Plus plans will pay for 15% of major services under certain conditions. Blue Cross Blue Shield Dental Blue for Individuals PPO plan will cover at least 30% of major services. Their Core Plan will cover 50% of major services as long as you meet your $75 deductible. Check with your insurance provider before scheduling your surgery so you know exactly what you will need to pay. Just because you have dental coverage, does not mean your gum graft will be covered.
To give you an idea of how gum graft cost can vary, consider what the following patients paid out of pocket for their procedure based on where they live and how many areas were operated on. (More examples can be found on the Cost Helper Health website here.)
Areas operated: 3
Patient paid: $2,835.00
State: New York
Areas operated: entire mouth
Patient paid: $8,400.00
Areas operated: 3
Patient paid: $0.00
If the tissue is grafted from your own mouth, the procedure will be less expensive. Tissue taken from a tissue bank costs more, which will make the surgery cost more. Talk to your periodontist about where the tissue will come from to make sure you’re getting the most cost-effective option.
When it comes to gum graft cost, I recommend you speak with your insurance provider (if you have one) and your dentist or periodontist before surgery to determine exactly how much you will need to pay out of pocket.